Sadly, I recently perused Ruth Lawrence's new book, and indeed on p 883,
she does indicate that breastmilk must be discarded for the first 24
hours of therapy with a group A pharyngitis.  She also indicates on the
same page that breastfeeding is acceptable after 24 hours of therapy for
group B strep endometritis.  All of which seems outrageous to me, since
very seldom (if ever) would a group A strep be carried by hematogenous
spread unless the mother was gravely ill.  Accordingly, withholding
breast milk from an infant whose mother has group B strep endometritis
seems absurd.  The infant has most likely come through a colonized
passageway, and it's risk of a initial infection through the unlikely
strep in breast milk (again, what's the likelihood of hematogenous
spread) seems almost absurd, compared to the infant's risk of already
having been exposed to the bug.

I read all of these changes with a very heavy heart.  They are taken
from "Hospital Infection Control Practices Advisory Committee guidelines
for isolation precautions in hospitals" and little real thinking seems
to have taken place regarding the actual risk of organism transmission
and breastfeeding. Also, there is no discussion of risk vs. benefit to
the infant.   I regretted deeply that I had even read this info, and
have been waiting for the flame from lactnetters.

Denise Sweeney, RN, IBCLC
Mobile, AL

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